Predictive value of normal sperm morphology in intrauterine insemination (IUI) : a structured literature review

Van Waart, J. (Johannes) (2001-12)

Thesis (MMed)--Stellenbosch University, 2001.

Thesis

ENGLISH ABSTRACT: The aim of the study was to conduct a structured review of the literature published on the use of normal sperm morphology, as an indicator of male fertility potential in intrauterine insemination (M) programs. Published literature in which normal sperm morphology was used to predict pregnancy outcome in lUI during the period 1984 - 1998 was reviewed. Four hundred and twenty one articles were identified. Eighteen provided data that could be tabulated and analyzed. Eight of the analyzed studies provided sufficient data for statistical analysis. Six studies used the Tygerberg strict criteria and two the WHO guidelines (1987, 1992). A meta-analysis of the six studies in the strict morphology group yielded a risk difference (RD) between the pregnancy rates achieved in the patients below and above the 4% strict criteria threshold of -0.07 (95% CI: -0.11 to -0.03; p< 0.001). WHO criteria group (1987,1992) had insufficient data to be analysed. Meta-analysis showed a significant improvement in pregnancy rate above 4% threshold for strict criteria. Accurate evaluation of normal sperm morphology results should be an integral part of evaluating the male factor.

AFRIKAANSE OPSOMMING: Die doel van die studie was om 'n gestruktureerde literatuuroorsig van die gepubliseerde data oor normale sperm morfologie uit te voer om vas te stelof dit enige waarde het as voorspeller van manlike fertiliteitspotensiaal in intra uteriene inseminasie (lUI) programme. Gepubliseerde literatuur waar normale sperm morfologie gebruik IS om swangerskapsuitkoms te voorspel met IUI in die tydperk 1984 - 1998 is nagegaan. Vierhonderd een en twintig artikels is geïdentifiseer. Agtien het genoeg data gehad om te kan tabuleer en analiseer. Agt van die geanaliseerde studies het voldoende data gehad vir statistiese analise. Ses studies het die Tygerberg streng kriteria gebruik en twee die WGO (1987, 1992) riglyne. 'n Meta-analise van die ses studies in die streng kriteria groep het 'n risiko verskil tussen swangerskapstempo in pasiënte onder en bo die 4% streng kriteria afsnypunt, van -0,07 (95% betroubaarheidsindeks: -0.11 tot -0.03; p<O.OOl) getoon. Die WGO kriteria (1987,1992) groep het onvoldoende data gehad om te kan analiseer. Meta-analise het 'n bekenisvolle verbetering in swangerskapuitkoms bo die 4% afsnypunt getoon vir die streng kriteria. Akkurate evaluasie van normale sperm morfologie resultate behoort 'n integrale deel te wees van die proses om die manlike faktor in infertilteitsbehandeling volledig te evalueer.

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